Browsing by Author "Nxumalo, Nonhlanhla Lynette"

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    Community health workers, community participation and community level inter-sectoral action: the challenges of implementing primary health care outreach services
    (2014-04-25) Nxumalo, Nonhlanhla Lynette
    Background: The recognition of growing health disparities globally and, in particular Sub-Saharan’s continued poor health outcomes, has been responded to with a call to revitalise primary health care (PHC) 30 years after the Alma-Ata Declaration. Despite some limitations, and although not the only solution, community health workers (CHWs) have been shown to be able to reduce factors that can act as barriers to accessing care. However, CHW programmes (often provided by non-governmental organisations in South Africa) have historically been poorly regulated and fragmented. The South African government has proposed to address the health inequities through a series of health system reforms. One of these has been a current attempt to strengthen PHC through the use CHWs in order to reach underserved communities. The capacity of CHWs to provide effective outreach services remains unclear. This work examined the experiences of CHWs in their efforts to improve access to care through community participation and outreach services that work across sectors. Aim: The study aimed to examine the implementation of community health worker-provided services through the comparison of three case studies in order to identify enabling and constraining factors. Methodology: A case study method was used to compare three CHW programmes. Qualitative methods such as key informant interviews, participant observations, focus group discussions and network maps, were used to collect data. A thematic content analysis was used to identify a priori and emergent themes. Results: CHWs operate in communities with multifaceted needs (food, transport, health and social welfare services) requiring a comprehensive approach. The experiences of households in this thesis illustrate the various barriers to accessing services. The success and sustainability of CHW programmes depends on the ongoing commitment of resources, including investment in quality training, supervision, mentoring and organizational support. Furthermore, government institutional contexts with poor cross-sectoral integration, conflicting departmental mandates and poor accountability constrain the efforts of CHWs at local level. Operating within a community with strong social cohesion and social capital provided an enabling environment for CHWs to mobilise the community and facilitate community participation, which is crucial for implementation of cross-sectoral outreach activities. Conclusion: The study indicates that CHWs provide services in communities that live in poverty which results in multiple problems that contribute to ill health. The study goes further to illustrate that in order to strengthen outreach services across relevant sectors, the role of central government is crucial. These findings indicate a need for greater understanding about how to strengthen institutional contexts both in government and in non-governmental organisations.
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    A rapid appraisal of the status of the Antitretroviral Programme in facilities where roll out has started and those where roll out is planned in Gauteng Province - Central Wits Region
    (2006-11-01T12:59:16Z) Nxumalo, Nonhlanhla Lynette
    When the South African government decided to implement the roll out of antiretrovirals (ARVs) in public health facilities, as part of its HIV/AIDS care and treatment plan, there was concern about the capacity of the country’s health care system, to deliver the service efficiently and equitably. The study was deemed necessary, due to that the South African government requires information and feedback on the state of its health care system to provide ARVs in public health facilities. The study will add to the growing body of knowledge on the status of the ARV programme and therefore assist in the improvement of the efficiency and efficacy of the services. The objective of this study was to conduct a rapid appraisal of the status of roll out of the ARVs in facilities that had begun offering the service and the readiness of facilities that were planning to roll out, in the Gauteng Province. Focus was on the capacity of these facilities to provide the ARV services, as outlined by the Provincial Department of Health. It is a descriptive cross- sectional study, drawing on qualitative methods such as thematic analysis, document review and a facility checklist. A sample was determined by purposely selecting participants who were involved in the ARV programme. Participants included facility managers, doctors and nurses from the study facilities, regional managers and representatives from non-profit organisations. Perspectives about the roll out were drawn from in-depth interviews from 27 participants, including document reviews and a facility checklist. The study highlighted the fact that the ARV programme is implemented within a health care system that is experiencing weaknesses and bottleneck problems in the following facets: human resources, training, referral systems, management and monitoring and evaluation systems. Findings indicated that the core weaknesses and constraints in the implementation of ARVs are systemic and hence will require intervention at a systemic level. It is recommended that the Department of Health improve the recruitment and retaining of health professionals, improve training and training structures, improve communication channels and support systems, provide skills to local government, managers and improve monitoring and evaluation systems.